{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T11:38:10Z","timestamp":1788781090525,"version":"build-2803163510"},"reference-count":33,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T00:00:00Z","timestamp":1765152000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["81901740"],"award-info":[{"award-number":["81901740"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82471978"],"award-info":[{"award-number":["82471978"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82271993"],"award-info":[{"award-number":["82271993"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100007129","name":"Natural Science Foundation of Shandong","doi-asserted-by":"publisher","award":["ZR2024MH069"],"award-info":[{"award-number":["ZR2024MH069"]}],"id":[{"id":"10.13039\/501100007129","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Postdoctoral Innovative Project of Shandong Province","award":["SDCX-ZG- 202303062"],"award-info":[{"award-number":["SDCX-ZG- 202303062"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,3,27]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Patent foramen ovale (PFO) is associated with a variety of clinical events; however, its association with major adverse cardiovascular events (MACEs) in patients with coronary artery disease (CAD) remains unclear. The objective of our study was to compare the prognosis between patients with and without PFO and to investigate the association between PFO and MACEs in patients with CAD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>This study retrospectively included 2667 patients who underwent coronary computed tomography angiography (CCTA) for the evaluation of suspected CAD. MACEs were defined as cardiac death, non-fatal myocardial infarction, and ischemic stroke. The primary endpoint was a composite of cardiac death and non-fatal myocardial infarction. The secondary endpoint was defined as ischemic stroke. After a median follow-up of 86 months (interquartile range: 74\u201399 months), 288 patients experienced MACEs, among whom 203 patients had the primary endpoint and 85 patients had the secondary endpoint. Compared with patients without PFO, patients with PFO had a higher cumulative incidence of MACEs (P &amp;lt; 0.001), as well as higher cumulative incidence rates for both the primary endpoint (P &amp;lt; 0.001) and secondary endpoint (P &amp;lt; 0.001). PFO was significantly associated with MACEs in patients with CAD (HR = 3.82, P &amp;lt; 0.001). In multivariate analysis, PFO remained an independent predictor of MACE in patients with CAD (HR = 2.98, P &amp;lt; 0.001), with consistent results observed in the analyses of both the primary endpoint and secondary endpoint (All P &amp;lt; 0.001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>PFO is associated with adverse prognosis in patients with CAD, and patients with PFO have a higher risk of MACEs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjci\/jeaf346","type":"journal-article","created":{"date-parts":[[2025,12,4]],"date-time":"2025-12-04T13:16:25Z","timestamp":1764854185000},"page":"913-923","source":"Crossref","is-referenced-by-count":1,"title":["Patent foramen ovale is a significant risk factor for patients with coronary artery disease: a long-term follow-up study"],"prefix":"10.1093","volume":"27","author":[{"given":"Bowen","family":"Li","sequence":"first","affiliation":[{"name":"Department of Radiology, Shandong First Medical University (Shandong Academy of Medical Sciences) , Jinan, Shandong 250117 ,","place":["China"]},{"name":"Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University , #324, Jingwu Road, Jinan, Shandong 250021 ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huimin","family":"Yan","sequence":"additional","affiliation":[{"name":"Department of Radiology, Shandong First Medical University (Shandong Academy of Medical Sciences) , Jinan, Shandong 250117 ,","place":["China"]},{"name":"Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University , #324, Jingwu Road, Jinan, Shandong 250021 ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xueqiao","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Radiology, Shandong First Medical University (Shandong Academy of Medical Sciences) , Jinan, Shandong 250117 ,","place":["China"]},{"name":"Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University , #324, Jingwu Road, Jinan, Shandong 250021 ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huiyu","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Radiology, Shandong First Medical University (Shandong Academy of Medical Sciences) , Jinan, Shandong 250117 ,","place":["China"]},{"name":"Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University , #324, Jingwu Road, Jinan, Shandong 250021 ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Runze","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Radiology, Shandong First Medical University (Shandong Academy of Medical Sciences) , Jinan, Shandong 250117 ,","place":["China"]},{"name":"Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University , #324, Jingwu Road, Jinan, Shandong 250021 ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jian","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Radiology, Central Hospital Affiliated to Shandong First Medical University , Jinan, Shandong 250021 ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xianshun","family":"Yuan","sequence":"additional","affiliation":[{"name":"Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University , #324, Jingwu Road, Jinan, Shandong 250021 ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ximing","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University , #324, Jingwu Road, Jinan, Shandong 250021 ,","place":["China"]},{"name":"Department of Radiology, Shandong Provincial Hospital, Shandong University , Jinan, Shandong 250021 ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8312-9536","authenticated-orcid":false,"given":"Hui","family":"Gu","sequence":"additional","affiliation":[{"name":"Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University , #324, Jingwu Road, Jinan, Shandong 250021 ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,12,8]]},"reference":[{"key":"2026032620565582200_jeaf346-B1","doi-asserted-by":"crossref","first-page":"Itc17","DOI":"10.7326\/AITC201908060","article-title":"Stable ischemic heart disease","volume":"171","author":"Katz","year":"2019","journal-title":"Ann Intern Med"},{"key":"2026032620565582200_jeaf346-B2","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1016\/j.echo.2009.12.008","article-title":"Patent foramen ovale: echocardiographic detection and clinical relevance in stroke","volume":"23","author":"Di Tullio","year":"2010","journal-title":"J Am Soc Echocardiogr"},{"key":"2026032620565582200_jeaf346-B3","doi-asserted-by":"crossref","first-page":"2262","DOI":"10.1056\/NEJMoa071422","article-title":"Patent foramen ovale and cryptogenic stroke in older patients","volume":"357","author":"Handke","year":"2007","journal-title":"N Engl J Med"},{"key":"2026032620565582200_jeaf346-B4","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/S0025-6196(12)60336-X","article-title":"Incidence and size of patent foramen ovale during the first 10 decades of life: an autopsy study of 965 normal hearts","volume":"59","author":"Hagen","year":"1984","journal-title":"Mayo Clin Proc"},{"key":"2026032620565582200_jeaf346-B5","doi-asserted-by":"crossref","first-page":"1148","DOI":"10.1056\/NEJM198805053181802","article-title":"Prevalence of patent foramen ovale in patients with stroke","volume":"318","author":"Lechat","year":"1988","journal-title":"N Engl J Med"},{"key":"2026032620565582200_jeaf346-B6","doi-asserted-by":"crossref","first-page":"1063","DOI":"10.1161\/CIRCULATIONAHA.104.524371","article-title":"Patent foramen ovale and stroke","volume":"112","author":"Homma","year":"2005","journal-title":"Circulation"},{"key":"2026032620565582200_jeaf346-B7","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1016\/S0735-1097(85)80103-0","article-title":"Severe hypoxemia due to shunting through a patent foramen ovale: a correctable complication of right ventricular infarction","volume":"5","author":"Bansal","year":"1985","journal-title":"J Am Coll Cardiol"},{"key":"2026032620565582200_jeaf346-B8","doi-asserted-by":"crossref","first-page":"663","DOI":"10.1111\/j.1526-4610.2006.00433.x","article-title":"Patent foramen ovale and migraine\u2013bringing closure to the subject","volume":"46","author":"Schwedt","year":"2006","journal-title":"Headache"},{"key":"2026032620565582200_jeaf346-B9","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1016\/S0140-6736(89)90064-0","article-title":"Patent foramen ovale and decompression sickness in divers","volume":"1","author":"Moon","year":"1989","journal-title":"Lancet"},{"key":"2026032620565582200_jeaf346-B10","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.jcct.2021.10.010","article-title":"The U.S. Multi-societal chest pain guideline\u2014a quick look into a long-awaited document","volume":"16","author":"Ferencik","year":"2022","journal-title":"J Cardiovasc Comput Tomogr"},{"key":"2026032620565582200_jeaf346-B11","doi-asserted-by":"crossref","first-page":"702","DOI":"10.1148\/radiol.2343031047","article-title":"Atrial fibrillation: multi-detector row CT of pulmonary vein anatomy prior to radiofrequency catheter ablation\u2013initial experience","volume":"234","author":"Jongbloed","year":"2005","journal-title":"Radiology"},{"key":"2026032620565582200_jeaf346-B12","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1136\/hrt.2006.097782","article-title":"64 multidetector CT in patent foramen ovale","volume":"93","author":"Saremi","year":"2007","journal-title":"Heart"},{"key":"2026032620565582200_jeaf346-B13","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1016\/j.jcct.2016.10.002","article-title":"SCCT guidelines for the performance and acquisition of coronary computed tomographic angiography: a report of the society of cardiovascular computed tomography guidelines committee: endorsed by the north American society for cardiovascular imaging (NASCI)","volume":"10","author":"Abbara","year":"2016","journal-title":"J Cardiovasc Comput Tomogr"},{"key":"2026032620565582200_jeaf346-B14","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1016\/j.jcct.2014.07.003","article-title":"SCCT guidelines for the interpretation and reporting of coronary CT angiography: a report of the society of cardiovascular computed tomography guidelines committee","volume":"8","author":"Leipsic","year":"2014","journal-title":"J Cardiovasc Comput Tomogr"},{"key":"2026032620565582200_jeaf346-B15","doi-asserted-by":"crossref","first-page":"1007","DOI":"10.1093\/eurheartj\/ehr465","article-title":"Automated quantification of coronary plaque with computed tomography: comparison with intravascular ultrasound using a dedicated registration algorithm for fusion-based quantification","volume":"33","author":"Boogers","year":"2012","journal-title":"Eur Heart J"},{"key":"2026032620565582200_jeaf346-B16","doi-asserted-by":"crossref","first-page":"684","DOI":"10.1016\/j.jacc.2014.05.039","article-title":"High-risk plaque detected on coronary CT angiography predicts acute coronary syndromes independent of significant stenosis in acute chest pain: results from the ROMICAT-II trial","volume":"64","author":"Puchner","year":"2014","journal-title":"J Am Coll Cardiol"},{"key":"2026032620565582200_jeaf346-B17","doi-asserted-by":"crossref","first-page":"440","DOI":"10.1016\/j.jcmg.2010.02.003","article-title":"The napkin-ring sign: CT signature of high-risk coronary plaques?","volume":"3","author":"Maurovich-Horvat","year":"2010","journal-title":"JACC Cardiovasc Imaging"},{"key":"2026032620565582200_jeaf346-B18","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1148\/radiol.2501080559","article-title":"Patent foramen ovale: diagnosis with multidetector CT\u2013comparison with transesophageal echocardiography","volume":"250","author":"Kim","year":"2009","journal-title":"Radiology"},{"key":"2026032620565582200_jeaf346-B19","doi-asserted-by":"crossref","first-page":"1545","DOI":"10.1016\/0002-8703(92)90070-C","article-title":"Transesophageal contrast echocardiography and color flow mapping: methods of choice for the detection of shunts at the atrial level?","volume":"124","author":"de Belder","year":"1992","journal-title":"Am Heart J"},{"key":"2026032620565582200_jeaf346-B20","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1016\/S0894-7317(14)80395-7","article-title":"Accuracy of color Doppler transesophageal echocardiography for diagnosis of patent foramen ovale","volume":"7","author":"Berkompas","year":"1994","journal-title":"J Am Soc Echocardiogr"},{"key":"2026032620565582200_jeaf346-B21","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1148\/radiol.2492080175","article-title":"Imaging of patent foramen ovale with 64-section multidetector CT","volume":"249","author":"Saremi","year":"2008","journal-title":"Radiology"},{"key":"2026032620565582200_jeaf346-B22","doi-asserted-by":"crossref","first-page":"8983","DOI":"10.1007\/s00330-021-08037-y","article-title":"The role of cardiac CT throughout the full cardiac cycle in diagnosing patent foramen ovale in patients with acute stroke","volume":"31","author":"Lee","year":"2021","journal-title":"Eur Radiol"},{"key":"2026032620565582200_jeaf346-B23","doi-asserted-by":"crossref","first-page":"e038899","DOI":"10.1161\/JAHA.124.038899","article-title":"Burden of coronary artery disease as a predictor of new vascular events and mortality in patients with ischemic stroke: insights from the Norwegian stroke in the young study","volume":"14","author":"Jibril","year":"2025","journal-title":"J Am Heart Assoc"},{"key":"2026032620565582200_jeaf346-B24","doi-asserted-by":"crossref","first-page":"1370","DOI":"10.1016\/S0735-1097(85)80228-X","article-title":"Diagnosis and classification of atrial septal aneurysm by two-dimensional echocardiography: report of 80 consecutive cases","volume":"6","author":"Hanley","year":"1985","journal-title":"J Am Coll Cardiol"},{"key":"2026032620565582200_jeaf346-B25","doi-asserted-by":"crossref","first-page":"1504","DOI":"10.1378\/chest.107.6.1504","article-title":"The incidence of patent foramen ovale in 1,000 consecutive patients. A contrast transesophageal echocardiography study","volume":"107","author":"Fisher","year":"1995","journal-title":"Chest"},{"key":"2026032620565582200_jeaf346-B26","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/S0140-6736(88)92944-3","article-title":"Patent foramen ovale in young stroke patients","volume":"2","author":"Webster","year":"1988","journal-title":"Lancet"},{"key":"2026032620565582200_jeaf346-B27","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1016\/j.jcmg.2023.05.020","article-title":"AI-Guided Quantitative plaque staging predicts long-term cardiovascular outcomes in patients at risk for atherosclerotic CVD","volume":"17","author":"Nurmohamed","year":"2024","journal-title":"JACC Cardiovasc Imaging"},{"key":"2026032620565582200_jeaf346-B28","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1016\/j.jcct.2017.11.009","article-title":"Patent foramen ovale in patients with pulmonary embolism: a prognostic factor on CT pulmonary angiography","volume":"12","author":"Zhang","year":"2018","journal-title":"J Cardiovasc Comput Tomogr"},{"key":"2026032620565582200_jeaf346-B29","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1212\/WNL.0b013e3182a08d59","article-title":"An index to identify stroke-related vs incidental patent foramen ovale in cryptogenic stroke","volume":"81","author":"Kent","year":"2013","journal-title":"Neurology"},{"key":"2026032620565582200_jeaf346-B30","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1212\/WNL.0000000000000589","article-title":"Recurrent stroke predictors differ in medically treated patients with pathogenic vs. Other PFOs","volume":"83","author":"Thaler","year":"2014","journal-title":"Neurology"},{"key":"2026032620565582200_jeaf346-B31","doi-asserted-by":"crossref","first-page":"1011","DOI":"10.1056\/NEJMoa1705915","article-title":"Patent foramen Ovale closure or anticoagulation vs. Antiplatelets after stroke","volume":"377","author":"Mas","year":"2017","journal-title":"N Engl J Med"},{"key":"2026032620565582200_jeaf346-B32","first-page":"463","article-title":"Patent foramen Ovale embryology, anatomy, and physiology","volume":"42","author":"Mohammad","year":"2024","journal-title":"Cardiol Clin"},{"key":"2026032620565582200_jeaf346-B33","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.ijcard.2021.07.007","article-title":"Association between acute myocardial infarction and death in 386 patients with a thrombus straddling a patent foramen ovale","volume":"342","author":"Shah","year":"2021","journal-title":"Int J Cardiol"}],"container-title":["European Heart Journal - Cardiovascular Imaging"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ehjcimaging\/advance-article-pdf\/doi\/10.1093\/ehjci\/jeaf346\/65806678\/jeaf346.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjcimaging\/article-pdf\/27\/4\/913\/65806678\/jeaf346.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjcimaging\/article-pdf\/27\/4\/913\/65806678\/jeaf346.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T00:57:05Z","timestamp":1774573025000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ehjcimaging\/article\/27\/4\/913\/8374372"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,8]]},"references-count":33,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,12,8]]},"published-print":{"date-parts":[[2026,3,27]]}},"URL":"https:\/\/doi.org\/10.1093\/ehjci\/jeaf346","relation":{},"ISSN":["2047-2404","2047-2412"],"issn-type":[{"value":"2047-2404","type":"print"},{"value":"2047-2412","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,4]]},"published":{"date-parts":[[2025,12,8]]}}}